Provider Demographics
NPI:1760915409
Name:SEPPO CHIROPRACTIC
Entity Type:Organization
Organization Name:SEPPO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPPO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-357-7289
Mailing Address - Street 1:12330 JAMES ST
Mailing Address - Street 2:SUITE B065
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12330 JAMES ST
Practice Address - Street 2:SUITE B065
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8689
Practice Address - Country:US
Practice Address - Phone:616-594-0214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty